Inspection on 17/05/06 for Breckside Park Residential Home

This inspection was carried out on 17th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Breckside Park Residential Home 06/11/09

Breckside Park Residential Home 17/09/08

Breckside Park Residential Home 05/04/07

Breckside Park Residential Home 03/11/06

Breckside Park Residential Home 15/11/05

Breckside Park Residential Home 20/07/05

Breckside Park Residential Home 01/02/05

Breckside Park Residential Home 13/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Breckside Park Residential Home 10 Breckside Park Anfield Liverpool Merseyside L6 4DL Lead Inspector Debbie Corcoran Unannounced Inspection 09:30 17th & 18th May 2006 X10029.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Breckside Park Residential Home DS0000025331.V291582.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and Care Homes for Adults 18 – 65*. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Breckside Park Residential Home DS0000025331.V291582.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Breckside Park Residential Home Address 10 Breckside Park Anfield Liverpool Merseyside L6 4DL 0151 260 6491 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Keshav Khistria Mrs Kirti Khistria Care Home 26 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (3), Old age, of places not falling within any other category (21), Physical disability (2) Breckside Park Residential Home DS0000025331.V291582.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate six (6) named persons under the age of 65 years in the overall number of twenty six (26). 15th November 2005 Date of last inspection Brief Description of the Service: Breckside Park is a registered care home providing personal care for up to 26 residents in the category of older people. The home has been granted variations to the registered status to permit the care and support of named people in the category, younger disabled. The home is situated in the Anfield area of Liverpool and is close to parks, shops and public transport routes. Communal space within the home consists of 2 lounges, a dining room and a large conservatory. The home has 26 single bedrooms five of which have an en-suite WC. The home benefits from a large enclosed rear garden and further garden areas to the side and front aspects of the home. Breckside Park Residential Home DS0000025331.V291582.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and was carried out over a period of 14 hours over 2 consecutive days. Throughout the inspection 6 residents were spoken with on a one to one basis and the majority of residents were met. The manager of the home and all staff on duty were spoken with. Records which were examined included resident’s assessments and care plans, staff files, health and safety records and checks, accident and incident reports, residents’ monies and a number of key policies and procedures. Comment cards were left for resident’s relatives and other visitors to the home. A tour of the premises was carried out. This covered all areas with the exception of a small number of resident’s bedrooms. What the service does well: A number of the residents gave some good feedback on the quality of care and support provided at the home and they reported staff to be helpful. The majority of residents spoken with said the food was ‘good’ and that they have a choice of meals. Meals were well presented appeared appetising. Residents are encouraged to make choices as to their daily routines and are choosing when to go to bed in the evenings and what time to get up in the mornings and they reported that the care staff are respectful when supporting them with personal care tasks. Staff were observed to be pleasant and respectful to residents and welcoming to visitors. There are a total of eighteen care staff working at the home and of these 9 are reported to have attained an N.V.Q (National Vocational Qualification) in care. Breckside Park Residential Home DS0000025331.V291582.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Throughout the inspection there was significant evidence that the home is failing to meet many of the National Minimum Standards and the Care Home Regulations 2001. The home’s referral and admissions procedures are poor and need to be developed. The home has admitted residents with needs which are not being met by staff at the home, the residents are not within the agreed category of registration of the home, therefore the home is in breach of it’s conditions of registration, requirements have been given to the home to make sure they comply with the Care Home Regulations 2001.Some residents have been admitted to the home without an appropriate assessment of their needs having been carried out. A comprehensive assessment of the residents should always be carried out by suitably qualified and experienced person in order to ensure that the prospective residents needs can be met at the home. Social Services / Care management assessments should always be requested were a prospective resident is referred by Social Services. The manager has been required to review the provision of care to a number of residents as a matter of priority. The home has a statement of purpose, however this contains incorrect and out of date information and needs to be updated to include changes at the home. The resident’s do not have appropriate care plans and care plans are not being reviewed monthly. Care plans do not describe the care needs of the residents for their personal or health care and risk assessments are not carried out appropriately. The care plans are not being reviewed monthly. Information on the resident’s health related needs and appointments are not being recorded. The home is therefore failing to evidence that the resident’s health related needs are being met. Medication procedures need to be addressed (as identified in the body of the report). Care staff are responsible for the administration of medication but they have not been provided with training in this. This places residents at risk. Breckside Park Residential Home DS0000025331.V291582.R01.S.doc Version 5.1 Page 7 The home has a complaints procedure. However, complaints have not been logged appropriately and a record of how the complaint has been investigated and the outcome to the complainant has not been made. The home has an adult protection policy and procedure. However, the manager and staff need training in adult protection. A recent potential adult protection issue had not been dealt with appropriately and relevant agencies were not notified. There have been a number of recent incidents at the home which could have jeopardised the safety of residents and which have proved as a risk to the safety of staff. These concerns have not been addressed and therefore both staff and residents continue to be at risk. The home’s fire safety practices need to be improved and the manager has been required to request a visit from the Fire Authority. A fire risk assessment should be carried out and fire drills should be carried out regularly and staff should also be trained in fire safety. The home environment should be improved upon. There is no maintenance plan for the home and there are a number of areas require improvement as noted in the main body of the report. A staff training analysis should be carried out to identify core training needs for care staff and a training plan should be developed which is linked to making sure the home can meet the needs of the residents. Not all staff are trained in mandatory health and safety skills. For example some staff do not have moving and handling training and fire safety training. The home has not had a registered manager for a significant period of time and this has had an impact on the management of the home and the quality of the service provided. The registered person must ensure that the home is managed by a suitably qualified, experienced and competent manager who is registered with the Commission. Staff are not being provided with regular supervision and there are no staff meetings, with the exception of one held recently. This means that staff have no formal and effective means of communicating and discussing issues about the home, the needs of the residents, addressing matters which affect the residents and identifying their training and development needs. The home has no system of quality assurance at all and therefore no means of measuring the quality of the service provided. The registered person should introduce a system of quality assurance which includes surveying the residents and their relatives on the quality of the service. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Breckside Park Residential Home DS0000025331.V291582.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Breckside Park Residential Home DS0000025331.V291582.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6 (Older people) 1, 2 (Adults 18 –65) Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The home has a statement of purpose which needs to be updated to reflected changes at the home so as to ensure residents and prospective residents have up to date and accurate information. The home’s referral and assessment procedures are poor. Residents needs are not being assessed appropriately and the home is accommodating residents whose needs cannot be met without compromising the safety and welfare of other residents and of staff. Breckside Park Residential Home DS0000025331.V291582.R01.S.doc Version 5.1 Page 10 EVIDENCE: The home has a statement of purpose and service user guide. Both of these documents need to be updated to reflect changes in the home and should be made readily available to residents, prospective residents and their representatives. In order to assess the referral and admissions procedures for residents a number of residents files were examined and discussed with the manager and the home’s policies and procedures were checked. The findings of this was that the home is admitting residents without having attained community care assessments from Social Services, including residents who are potentially out of the category of registration of the home. The home has an assessment tool but this isn’t being used effectively and assessment information is poor. There were a number of examples whereby there was no information as to the needs of a resident even though it was clear that they may have significant care needs. The referral and admissions process is weak resulting in the home now providing for residents whose needs cannot be met safely and without jeopardising the safety of other residents at the home. The home needs a clear and structured admissions procedure. The current situation in terms of the inappropriate accommodation of residents is placing residents and (most of whom are older people) and staff in a vulnerable position and the manager is required to take immediate action to address this. The manager was advised that the home is breaching the conditions of registration in relation to the care needs and ages of the residents. The manager is required to apply to the Commission for a variation for those people under 65yrs who are not named individuals for registration of the home and for those residents who have more specialised needs. The manager must ensure a structured referral and assessment process to ensure that the home is not admitting people outside of the category of registration and whose needs can be met at the home. The home does not provide intermediate care and therefore this standard was not assessed. Breckside Park Residential Home DS0000025331.V291582.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service Users, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 (Older people) 6, 9, 16, 18, 19, 20 (Adults 18-65) Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The quality of care planning is poor and care plans give no indication as to how to meet the personal care and health care needs. Residents care needs are not being reviewed. There is little evidence that the residents are being appropriately supported with their health care. Medication administration procedures are not tight enough to ensure safe administration to residents and medication records are not being maintained accurately. Breckside Park Residential Home DS0000025331.V291582.R01.S.doc Version 5.1 Page 12 EVIDENCE: A sample of residents records were examined in order to assess the care planning in place for residents. Whilst each of the residents has a document referred to as a care plan these documents contain minimal information as to the persons needs and they are not a care plan. In effect the residents do not have a care plan and the home has no written information as to how to meet the resident’s needs and no evidence of how the residents care is being reviewed. This was the case for all residents sampled. Some of the residents have significant levels of care needs, there is however no information available as to how their needs are to be met. There was minimal and in many cases no information on how the resident’s health care needs are being met. Examples of this were seen in the care of residents who have diabetes. No care planning is in place for this and there was no evidence of any health related support, referrals or monitoring of the condition. There was only a statement that the person is ‘diabetic’. Another example was that the daily records for one of the residents stated that the person had a pressure area. There was no other reference to this on file, no evidence of referral for district nurse, no care planning as to how this was being managed, no risk assessment, no indication of infection control procedures and that staff would need to observe. The manager was informed to follow this up with GP / nurses and record this information appropriately in the residents care plan and care records. Residents records showed that there are some risk assessments relating to the resident’s care (these are in the form of a tick list). These are not consistently completed and give no indication of what the actual risk is to the resident or how to manager the risk. Numerous examples were discussed with the manager where a risk assessment is required in relation to the care of the residents. Examples of these included supporting residents who have moving and handling needs, supporting residents who use bed rails (no information in care planning as to use, no agreement, no risk assessment, no review) supporting residents who are prone to falling, supporting residents who can be challenging and present a risk to their own safety and the safety of other residents and staff. In some cases it was discussed that the risk assessment for some of the residents in terms of supporting them with challenging behaviour was so great that the home could not accommodate the person and meet the resident’s needs safely and the manager was required to take immediate action to address this. Residents records are minimal and there is no evidence that residents care and health needs are being met. The manager must ensure that there is a clear and auditable link between identifying a residents needs, ensuring an appropriate care plan is in place which meets the identified needs and ensuring Breckside Park Residential Home DS0000025331.V291582.R01.S.doc Version 5.1 Page 13 all risk assessments are in place. The manager must also show that he can link other sources of information into this. An example of this was that the accident records showed that a resident has suddenly become prone to falling on a regular basis. There had been no reassessment of the resident’s needs, no review of their care plan, no risk assessment or information regarding the prevention of falls and no evidence that the resident has been referred to relevant health professionals. The home owner has introduced a care planning tool, however, this is not being used effectively and the residents therefore do not have a care plan. Residents gave mixed views on their care. Some residents felt that it was very good and all their needs were met whilst others felt that staff could be more ready to take action if for example they felt unwell. A small number of visitors to the home made brief but complimentary comments on the home. For example “they couldn’t be more helpful and kind “ and “this home is fully recommended”. A number of residents looked like they had had little care or attention paid to their personal care. There is clearly an issue of choice in how the residents are presented or choosing to have support with their personal care. However, one of the resident’s in question said that they did not have any issues with staff supporting them in this area and this was discussed with the manager. Staff should pay more care attention to supporting the residents were this is appropriate. Medication receipt, storage and administration was checked. The manager has medication training and reported that he is requesting medications training for senior care staff. Senior care staff are responsible for administering medication but none of these staff have been provided with medication training. The manager was informed that it is a requirement that staff who are responsible for administering medication are appropriately trained. Medication administration records included a photograph of each of the residents. On this occasion a sample of medication was checked against the records. Medication storage was appropriate for the sample of medication checked and controlled drugs are stored and recorded safely. However there were number of practices which need to be addressed and these were discussed with the manager and include the following; where a medication has ceased this must be clearly recorded on the medication administration record and should include information as to which GP has withdrawn the medication, the date from which this took effect and should be double signed by staff. There were occasional gaps in signatures in relation to medication administration records. One medication administration record was signed as to date on top when it should have started to be signed from the correct date in the middle of the sheet. The balance of medication for one of the residents who had been prescribed antibiotics was not in line with the records, this was discussed with the manager to be addressed. Breckside Park Residential Home DS0000025331.V291582.R01.S.doc Version 5.1 Page 14 Resident’s daily choices are respected in that they are choosing when to get up, when to go to bed, they have a choice of meals, choice as to when they want support with their personal care. Many of the residents are easily able to express their choices and are doing so. Residents are clearly making choices as to how to spend their day and this will include going outside of the home on their own if they have the skills to be able to do this independently. Breckside Park Residential Home DS0000025331.V291582.R01.S.doc Version 5.1 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service Users have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 (Older people) 12, 13, 15, 17 (Adults 18-65) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents are encouraged to use the local community when they have the skills to do this independently. Residents who are unable to do this have very limited community access. There has been some improvement in the level of indoor activities for residents. Residents are provided with a choice of a well cooked meals and a varied diet. However, the home is failing to record when a resident requires a special diet or any has any particular nutritional needs. Breckside Park Residential Home DS0000025331.V291582.R01.S.doc Version 5.1 Page 16 EVIDENCE: The residents provided a good deal of feedback on activities. A small number said that they were happy with the activities. However, most said that there aren’t really many activities and the ones on are usually a board game. The manager has employed a member of staff who will have responsibilities for arranging activities and is reported to be awaiting pre employment checks before this person starts working at the home. The manager has made some effort to purchase activities for the residents. Visitors are welcome in the home at all reasonable times. Residents are going out and using community resources independently when they are able to. Residents who require support for community access are restricted in this by staffing levels. This may be improved with the introduction of an additional member of staff for activities. Throughout the inspection it was clear that residents are making choices as to their daily routine within the home and the residents choices are well respected. Many of the residents are well able to express their opinions and it is recommended that the manager introduces resident’s meetings to give the resident’s a forum in which to further express their views collectively and contribute to the running of the home and changes made. In order to assess the meals and food provided the menus were checked, the kitchen was checked including food in storage and health safety in the kitchen, many of the residents were asked to comment on the food and the chef was interviewed. On commenting on the food one of the residents said “we have a full breakfast Saturday and Sunday and the main meals are great”. A number of residents felt that there was always choice of the main meal of the day served at lunchtime but little choice other than soup and sandwiches for tea. Food was stored in good supply and stored safely. The kitchen was presented as clean and well organised. The chef was aware of the needs and likes and dislikes of meals for the residents. Residents reported the meals served on both days to be good and most appeared to enjoy their meals. Residents can have an alternative to the menu and this was noted to have been offered to a number of residents. Resident’s records should include information on their dietary requirements. Breckside Park Residential Home DS0000025331.V291582.R01.S.doc Version 5.1 Page 17 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service Users feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 (Older people) 22, 23 (Adults 18 –25) Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The home has a complaints procedure and residents are provided with information on how to make a complaint. However, complaint records are not showing that complaints are being investigated or responded to. The home has adult protection procedures. These are not well understood or implemented appropriately. Accident and incident records indicate that residents are not being protected from harm or potential abuse. EVIDENCE: The home has a Complaints procedure in place. An outline of this is available in the porch for residents and visitors to be aware of how to make a complaint. Complaints are recorded and these records were checked. The manager was informed that he must ensure that the nature of a complaint is recorded in sufficient detail and factually including the name of the complainant (where provided and not in breach of confidentiality) and the date on which the complaint was made. For each of the complaints viewed there was no indication of how the complaint had been investigated or of the outcome to the complainant. There have been 6 complaints made directly to the home in the past 12 months and additional complaints have been made directly to the Commission. The majority of complaints made directly to the home have been Breckside Park Residential Home DS0000025331.V291582.R01.S.doc Version 5.1 Page 18 made by members of staff complaining about issues which are as a result of the needs of the residents. The home has an adult protection policy which is clear and identifies that allegation should be referred to relevant agencies for example Social Services, the Police and the Commission. Some members of the staff team have had abuse training. This should be extended to include all members of care staff. A recent potential adult protection issue was raised at the home. Adult protection procedures were not implemented and the relevant authorities were not notified. The manager needs further training in recognising and responding to abuse and needs to be able to show competence in understanding and implementing the adult protection procedures and roles and responsibilities of relevant authorities. Accident and incident records were examined in some detail. A number of these showed that there have been some clear issues /accidents regarding the welfare of the residents but there is no evidence of actions taken to address the problems or prevent a reoccurrence. These were discussed with the manager during the inspection and must be addressed as a matter of priority. The home must improve the systems in place for protecting and safeguarding residents. It is not enough to record a matter and not address the issues involved. A number of incidents which had been brought to the attention of the inspector throughout the inspection had not been logged. Incidents which indicated potential serious risks to residents and staff had not been followed up with a risk assessment, risk management plan, care planning and there had been no communication with Social Services and no notification to the Commission. The registered person must ensure that all notifiable incidents are reported to the Commission in writing as required in Regulation 37 of the Care Home Regulations 2001. The manager must demonstrate that he has the skills and experience to deal with serious matters professionally and effectively in safeguarding the residents. Breckside Park Residential Home DS0000025331.V291582.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23, 26 (Older people) 24, 25, 30 (Adults 18-65) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. There is room for improvement in the general presentation and cleanliness of the home and there are areas which are clearly in need of attention including a number of the resident’s bedrooms. Breckside Park Residential Home DS0000025331.V291582.R01.S.doc Version 5.1 Page 20 EVIDENCE: The home provides care for up to 26 residents over 3 floors of accommodation. The home has 2 lounges, a dining room and a large conservatory. The home has 26 single bedrooms five of which have an en-suite WC. The home has a large well maintained and enclosed garden to the rear and further garden areas to the side and front of the home. The manager is intending to make better use of the gardens in the forthcoming months. A tour of the premises was carried out. All rooms across the home were looked at with the exception of a small number of resident’s bedrooms. The communal areas are generally maintained to an appropriate standard with exceptions being to the main hall and ground floor corridor and one area of the first floor landing. Some redecoration is required in the hall, particularly to the ceiling where the paper is hanging off. The carpet in the hallway and ground floor corridor is reported to be approximately 6 months old, however this needs to thoroughly cleaned or replaced as it was dirty. The conservatory is used regularly by residents and has become a room for playing pool. Some redecoration is required in the conservatory. 18 of the resident’s bedrooms were checked. Of these 11 were satisfactory in their presentation and facilities for residents. Seven of the rooms require attendance for either redecoration, re carpeting or due to the rooms being malodorous. The communal lounges are quite well maintained and welcoming. Arm chairs in one of the lounges need to be cleaned. One of the lounges is designated as the homes smoking area. A number of residents are also known to smoke in their rooms. The manager must review this and is required to ensure that appropriate risk assessments are carried out. The home has some aids and adaptations for those residents with mobility needs. There is access to the front of the house via a ramp. However, the manager must seek advice regarding the front step and ensure this offers safe access to the home for people who use wheelchairs. There was a recent example of where this has presented a risk to one of the residents. Some of the residents require the use of a hoist for transferring. Not all staff have been provided with training in moving and handling. This must be provided with staff in order to ensure the safety of residents, staff and to meet Moving and Handling Regulations. Not all of the residents have the facility to lock their bedroom. This should be provided to all residents unless determined as not appropriate as part of a risk assessment. One of the residents reported that he they have had items stolen from their room on a number of occasions. The home was presented as clean with the exception of those areas of décor and furnishings as noted above. Domestic staff work 6 days per week. The registered person should review this arrangement as care staff are carrying out Breckside Park Residential Home DS0000025331.V291582.R01.S.doc Version 5.1 Page 21 domestic duties one day per week and this is taking them from their care assistant role. The home does not have a maintenance plan. Breckside Park Residential Home DS0000025331.V291582.R01.S.doc Version 5.1 Page 22 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 (Older people) 32, 34, 35 (Adults 18-65) Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Residents are not being supported by a staff team who are appropriately trained in core health and safety skills. Staffing levels are not always appropriate to meet the needs of the residents. Staff recruitment practice is failing to protect residents. EVIDENCE: There are 3 care staff on duty throughout the day and this was confirmed through checking rotas, discussions with residents, discussions with staff and the manager. The manager is included in the staffing levels (this brings the number up to 4) This is not appropriate as the manager was observed to be very busy with managing the home during both days of the inspection and had minimal time to provide direct care to the residents. Care staff felt that there is adequate staffing until 4pm when the manager finishes and there are 3 care staff only. The registered person is required to review the staffing levels. Breckside Park Residential Home DS0000025331.V291582.R01.S.doc Version 5.1 Page 23 The home has achieved the target of 50 of care staff to be trained to N.V.Q level 2 in care as 9 of the 18 care staff have attained this or the level 3 award. The manager provided some information on staff training. However, this was not adequate to indicate that staff have been provided with training in core health and safety skills such as fire safety and moving and handling. The manager must ensure that the training needs of each member of staff are identified and ensure a training plan is in place to ensure training needs are met. Staff must be provided in core skills training in order to ensure the health and welfare of residents. Staff recruitment practices and procedures were checked by examining the staff files for 3 of the most recently recruited members of staff. The records showed that staff are providing employment references prior to starting work at the home and the manager is carrying out a pova first check but none of the 3 staff had a Criminal Records Bureau disclosure (CRB). The manager reported that he may have seen these from a previous employer for a number of staff. The requirements for CRB disclosures were discussed and the manager is required to ensure appropriate CRBs are carried out prior to commencement of employment. Residents gave positive feedback about the staff including “the staff are fine and they look after me”. Staff presented as caring during discussions and they were observed to interact well with the residents. A relative gave good feedback saying “they couldn’t be more helpful and kind”. Breckside Park Residential Home DS0000025331.V291582.R01.S.doc Version 5.1 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 (Older people) 37, 39, 42 (Adults 18-65) Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The home has not been well run or appropriately managed and this has made a clear impact on the quality of the service provided to residents. The home has no means for checking the quality of the service. The health, safety and welfare of staff is not being protected by the home’s fire procedures. Breckside Park Residential Home DS0000025331.V291582.R01.S.doc Version 5.1 Page 25 EVIDENCE: The home is failing to safeguard the health and safety of residents and there are clearly areas whereby the home has not been managed appropriately and effectively. The home has been without a qualified and adequately experienced and registered manager for some time and this is evident in the findings of this inspection. The current manager is intending to apply to the Commission for registration as manager. The home does not have a quality assurance process and has no means of effectively measuring the quality of care provided. The home does have a process by which it can demonstrate that residents are consulted upon and feedback on the standards of care offered. The registered person is required to adopt or produce a quality assurance system. Resident’s monies are being managed by the registered person. Records of these were checked and found to be appropriate. The storage of resident’s monies must be reviewed as a significant proportion of this is kept in one bank account which offers no facility for identifying the individual resident’s money and therefore any individual interest accrued. The registered person should ensure that residents money do not build up to large amounts before being banked. Staff records and discussions with staff show that staff are not being provided with one to one supervision. It is a requirement that staff receive regular and recorded supervision. Health and safety checks were examined. Gas and electricity safety certificate were checked and up to date. Portable hoists had been serviced recently. The manager reported that the registered person checks and records water temperatures on a regular basis but records to confirm this were not available for inspection in the absence of the registered person. Fire safety records were checked and these indicate that the fire alarm is tested weekly, emergency lighting is tested (but the frequency of this should be reviewed). The last fire drill was carried out on 12/10/05, these should take place at least every six months. Fire fighting equipment had been checked. There was little evidence of staff training in fire safety and no fire risk assessment. A number of residents smoke in their bedroom. There were no risk assessments in place for this. The manager was advised to address this with immediate effect. The manager was advised to contact the fire authority for advice and request a visit from a fire officer with immediate effect. The home has a safe working practice risk assessment dated 28/08/2000. There is no evidence that this has been reviewed or updated since this time. Breckside Park Residential Home DS0000025331.V291582.R01.S.doc Version 5.1 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 x 3 1 4 x 5 x 6 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 1 ENVIRONMENT Standard No Score 19 2 20 x 21 x 22 x 23 2 24 x 25 x 26 2 STAFFING Standard No Score 27 2 28 1 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 1 32 x 33 1 34 x 35 3 36 x 37 x 38 1 Breckside Park Residential Home DS0000025331.V291582.R01.S.doc Version 5.1 Page 27 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP31 Regulation 8 9 Requirement The registered person must employ a qualified, competent and experienced person to manage the home and this person must make an application for registration with the Commission. The registered person must ensure that the home meets the conditions of registration. The registered person must ensure that the home only admits residents whose needs can be met and within category of registration. The registered person must apply to the Commission for a variation for any residents whose needs are currently outside of the category of registration of the home. The registered person must ensure that residents are only admitted to the home following an assessment of their needs by a suitably qualified and experienced person. Timescale for action 18/07/06 2. OP4 12 (1) 18/06/06 3. OP3 12 14 18/06/06 Breckside Park Residential Home DS0000025331.V291582.R01.S.doc Version 5.1 Page 28 4. OP3 12 14 5. OP1 6 6. OP7 15 13 (4) (c) The registered person must arrange for the reassessment and review of a number of residents who may no longer be appropriately placed. The registered person must ensure that the statement of purpose is updated to include changes at the home. The registered person must ensure that each resident has a comprehensive care plan which is reviewed monthly. Care plans must describe the care needs of the residents for all aspects of their personal and health care. The registered person must ensure that risk assessments are carried out for risks associated with the residents care. Risk management plans must be developed from these were appropriate. The registered person must ensure that all health related information and appointments for residents are recorded. The registered person must ensure that residents are supported appropriately with their personal care and presentation. The registered person must ensure that medication is administrated safely and correctly and medication administration records are accurately and appropriately maintained. The registered person must ensure that staff who are responsible for the administration of medication are appropriately trained. 18/06/06 18/07/06 18/07/06 7. OP8 17 Schedule 3 12 (4)(a) 18/06/06 8. OP10 18/06/06 9. OP9 13 (2) 18/06/06 10. OP9 13 (2) 18/08/06 Breckside Park Residential Home DS0000025331.V291582.R01.S.doc Version 5.1 Page 29 11. OP16 12`(4) (a) The registered person must ensure that complaints and the outcome of these are recorded appropriately. 13 (6) 18/06/06 12. OP18 The registered person must 18/08/06 ensure that the manager and staff are provided with training in adult protection. The manager must be competent in dealing with an allegation and implementing adult protection procedures. The registered person must ensure that Incident and accident reports are completed at all times. The registered person must ensure that the Commission is notified of any events in the care home as identified under Regulation 37 of the Care Home Regulations 2001. The registered person must review and update the risk assessment for safe working practices. The registered person must ensure that the premises are kept in a good state of repair internally and externally and allow for safe access for all residents. All matters identified in the body of the report must be addressed. The registered person must ensure that a fire risk assessment is carried out. Risk assessments must be carried out in relation to resident’s smoking in their bedroom. Fire drills must be carried out regularly. The registered person must consult with the Fire Authority on fire safety precautions. DS0000025331.V291582.R01.S.doc 13. OP18 17 Schedule 3 37 18/06/06 14. OP38 18/06/06 15. OP38 13 18/07/06 16. OP19 23 (2) (b) 18/08/06 17. OP38 23 (4) 18/06/06 Breckside Park Residential Home Version 5.1 Page 30 18. OP28 19 (1) (b) 19. OP27 18 (1) (a) 20. OP30 18 (c ) (i) 21. 22. OP36 OP24 18 (2) 23 (2) (m) 24 23. OP33 The registered person must ensure that staff do not commence employment prior to receipt of all relevant pre employment checks. The registered person must review staffing levels. This must include a review of the manager being on duty as a member of care staff and a review of staffing after 4pm and when there is no domestic cover at the home. The registered person must ensure that staff are trained in core health and safety skills as appropriate to their role. The registered person must ensure that staff have regular and recorded supervision. The registered person must ensure that residents are provided with lockable storage space. The registered person must establish and maintain a system for reviewing and improving the quality of care provided at the home. 18/06/06 30/06/06 18/08/06 18/08/06 18/08/06 18/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP3 OP3 OP30 Good Practice Recommendations Referral and admissions procedures should be developed. Social Services assessments should always be requested were the person is referred by Social Services. An analysis of staff training should be carried out to identify core training needs for care staff and to identify training linked to the needs of the residents. A staff training plan should be developed linked to ensuring staff can meet the needs of the residents. DS0000025331.V291582.R01.S.doc Version 5.1 Page 31 Breckside Park Residential Home 4. 5. 6 7 OP35 OP12 OP18 OP14 The registered person should review the system for storing service users monies and the banking of this. Residents should be offered opportunities to be involved in a greater range of activities and in some community access. The homes manager should obtain a copy of Liverpool City Councils policies and procedures on adult protection. Residents should have the opportunity to participate in the decision making in the home and provide feedback on the quality of the care through resident’s meetings. Breckside Park Residential Home DS0000025331.V291582.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Breckside Park Residential Home DS0000025331.V291582.R01.S.doc Version 5.1 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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